Temporal trends in and associations with nonsteroidal anti-inflammatory drug prescription in adult and pediatric patients with inflammatory bowel disease.

Objective: Recent inflammatory bowel disease (IBD) treatment guidelines have recommended against NSAID use despite prevalent musculoskeletal symptoms and opioid overuse in this population. Given the discordance between changing national guidelines and potential clinical utility, we sought to assess national temporal trends in prescription NSAID and opioid use for patients with IBD and factors associated with NSAID fill.

Methods: This retrospective cohort study of adult and pediatric IBD patients used administrative claims data from 2000-2022. Prescription NSAID and opioid fills per calendar year were assessed. Wilcoxon-Cuzick test of trend and generalized estimating equation models evaluated NSAID and opioid fill trends and assessed characteristics associated with NSAID use.

Results: Among the 361,025 IBD patients, there was a significant decreasing trend in the proportion prescribed NSAIDs over time (p<0.01). Fill rates of NSAIDs were markedly lower than opioids across the study period despite an increase in musculoskeletal pain codes. In the multivariable model, opioid prescription (OR 2.13, 95% CI 2.11-2.15), a diagnostic code for osteoarthritis (OR 1.57, 95% CI 1.55-1.59) or unspecified joint pain (OR 1.54, 95% CI 1.52-1.56) had strong independent associations with NSAID fill, while age <18 or ≥ 80 years were associated with significantly lower odds of NSAID fill.

Conclusion: NSAIDs are used by a minority of patients with IBD with decreasing prescription rates over time despite high rates of opioid use and a doubling of musculoskeletal complaints. NSAID safety needs more thorough examination as an effective and potentially lower-risk analgesic option for patients of all ages with IBD.